This document discusses the benefits of implementing an electronic medical records (EMR) system for perinatal care. It notes that EMRs can help reduce medical errors, improve communication and patient safety, and support clinical decision making. The document also outlines how EMRs can help healthcare organizations meet meaningful use criteria, enhance defensive medicine practices, and potentially improve their financial bottom line over time. Overall, the document advocates for EMR adoption in perinatal care due to the clinical benefits and opportunities it provides.

1. Driving enterprise efficiency
through interoperability
Karen Triano Golin
GE Healthcare Consultant
The Institute of Medicine’s 1999 report, To Err is Human, set and outbound HL7 interfacing options are offered. Shared
a goal to help remedy a healthcare system compromised information enables the electronic medical record and helps
by preventable patient errors. One of their major enhance communication, patient safety, and quality.
recommendations to reduce medical error frequency
encouraged the use of medical informatics and electronic
record systems (Kohn LT, 2000). Bates and Gawande stated,
The United States Plays Catch Up
“If medicine is to achieve major gains in quality, it must be While many studies examining the role medical informatics
transformed, and information technology will play a key part, play began in the 1960s and 1970s (Hon EH, 1965; Kubli et
especially with respect to safety” (Bates, 2003). The American al., 1974; Rosen MG, 1978), EMR adoption in The United States
College of Obstetricians and Gynecologists’ continuing has been slow and lags far behind other countries. A survey
commitment to patient safety led them to classify seven of more than 10,000 primary care physicians in 11 countries
objectives in 2003 (updated in 2009), two of which focused (Schoen, Osborn, Doty, Squires, Peugh, & Applebaum, 2009)
on improving communication between medical staff and found that while 46% of U.S. primary care physicians are
patients including incorporation of technological solutions using an EMR, they have been embraced by more than 90%
(American College of, 2003; American College of, 2009). in Australia, Italy, the Netherlands, New Zealand, Norway,
Sweden, and the U.K. This slow growth is partly attributed to
Centricity* Perinatal remains a central component in hospitals’
the complexity as well as the heavy investment involved; “The
continuing endeavor toward excellence in managing the
share of hospitals adopting either basic or comprehensive
dynamic and complex healthcare needs of their patients.
electronic records has risen modestly, from 8.7 percent in
An electronic documentation system committed to providing
2008 to 11.9 percent in 2009” (Jha A, 2010). A 10 percent
accurate and timely information, Centricity Perinatal facilitates
increase in the adoption of basic EMRs, however, can
new levels of connectivity critical to enhancing patient care
reduce infant mortality by 16 deaths per 100,000 live
and increasing efficiency across the entire perinatal continuum
births (Miller, 2011).
of care. To further increase the reach and value delivered
from the entire system, a wide variety of inbound/ADT, lab, With more than 22 years of expertise within and commitment
to the perinatal continuum of care, Centricity Perinatal
continues to be a leader in the industry.

2. Steadfast Support of Centricity Perinatal
1975—2011
1975 1986 1990 1992 1995 1998 2005
QMI formed QS launched Crit Care L&D install Marquette GE buys QS renamed
install buys QMI Marquette as Centricity
Perinatal
Meaningful Use
In an attempt to accelerate EMR adoption in the U.S., the Centricity Perinatal version 6.9 has received Modular
federal government has committed unprecedented resources Certification. Modular certification indicates that Centricity
to encourage hospitals and practitioners to integrate the Perinatal supports some certification criteria associated with
appropriate EMR tools to advance patient safety and quality Meaningful Use objectives, helping to enable providers qualify
of care as well as improve efficiency and cost savings. for funding under the American Recovery and Reinvestment
Beginning in 2011, physicians who purchase and meet Act (ARRA).
“Meaningful Use” criteria for EMRs will be eligible for up to
Modular Certification for Centricity Perinatal 6.90 was
$44,000 in incentives. These incentives gradually decrease
received on March 21, 2011, Certificate Number: IG-2392-
until expiration in 2014 with much of the stimulus coming
11-0043 Certification Modular Certification, meeting the
in 2011 and 2012, so early qualifiers will receive more.
following criteria: 170.302(g) Smoking status; 170.302 (h)
Requirements for Meaningful Use include structured data
Advance Directives; 170.302(o) Access control; 170.302(p)
collection, health information exchange, clinical decision
Emergency access; 170.302(q) Automatic log-off; 170.302(r)
support, patient engagement, security assurance, and
Audit log; 170.302(s) Integrity; 170.302(t) Authentication;
quality reporting.
170.302(u) General encryption; 170.302(v) Encryption
The Certification Commission for Healthcare Information when exchanging electronic health information.
Technology has, since 2006, been certifying increasing levels
of functionality for EMR systems and has been petitioned by
the American Congress of Obstetricians and Gynecologists
Defensive Medicine
(ACOG) to incorporate their recommendations for specialty- NICU and Labor & Delivery (L&D) clinicians work in a highly
specific functionality criteria, underscoring the need for litigious arena with allegations of negligence or error often
distinct departmental solutions (McCoy M, 2010). Just as at the forefront (Haberman, Rotas, Perlman, & Feldman,
ACOG has lobbied for individualized guidelines, the American 2007). Ob/Gyn physicians are sued 2.17 times for every
Academy of Pediatrics has recognized that many general Ob/Gyn as compared to .95 for every 1 physician (American
EMR systems are of limited use in child health care as the Medical, 2010), and this fear of lawsuits is changing the way
systems are designed for adults and lack the data precision obstetricians and gynecologists practice with some leaving
necessary, for example, to process body weight to the the field at an early age. Though the majority of claims are
nearest gram which is essential to the care of all infants dropped or closed without payment, the litigious climate,
in the Neonatal Intensive Care Unit (NICU) (Spooner & the financial and emotional stress, and time spent combating
Council on Clinical Information Technology, 2007). claims and suits takes a toll. Of those with closed claims,
the average payment was $512,049 (Klagholz J, 2009). As
the patient-doctor relationship has transformed from one
of trust to one of “Show me,” an EMR, with its production
of a valid, reliable, and defensible medical record, adds
to a physician’s armamentarium. It helps provide critical
safeguards and minimizes legal risk—both necessary
in today’s world of medicine.
2

3. Nowhere is this more evident than in the role of fetal monitor Centricity Perinatal helps eliminate misplaced/lost paper
strips, which have proved so crucial that a body of decisional strips through electronic storage, managing records and
law has developed over their loss. The court may consider preservation while improving operational inefficiencies.
an absent fetal monitor strip as a generic missing document
and impose an adverse inference charge. In this situation,
the jury may draw conclusions against the defendant on any
Split-second Decisions
evidence related to the fetal monitor strip. The most severe Clinicians who practice in obstetrics and neonatology face
impact of losing the fetal monitor strip may be a separate challenges that often include the involvement of two lives,
cause of action for spoliation, defined as “the destruction… a high acuity environment, and long-term consequences
of evidence especially by a party for whom the evidence is that may result due to care decisions. In rapid-fire clinical
damaging” (“Spoliation,” 2001). Intentional or negligent loss decision-making L&Ds and NICUs where seconds count,
interferes with the plaintiff’s ability to prove her claim. This accuracy is non-negotiable. Situations can devolve quickly
effectively results in a default judgment, leaving only the into emergencies, so immediate access to information,
litigation of damages. One case example found “The fetal streaming clinical data integrated from multiple settings,
monitoring strips would give fairly conclusive evidence as and the ability to spot and intervene in deteriorating trends
to the presence or absence of fetal distress, and their loss are vital components in the point of care continuum.
deprives the plaintiff of the means of proving her medical
In today’s fast-paced environment, Mother-Baby Link (Figure 1)
malpractice claim against the Hospital” (“Baglio V. St. John’s”).
integrates critical maternal history and delivery data with the
infant record simply by linking their medical records, sharing
relevant and necessary information.
Figure 1.
3

4. Automated
(52.00%)
Installation in process
(1.32%)
Installation contracted
Not
(2.11%)
automated
(44.57%)
Figure 2.
Enhancing Patient Safety
This significant advantage in providing enhanced patient Point-of-Care Documentation through Centricity Perinatal
safety has been underutilized with almost 45% (1,987 units) annotations extends instantaneous access to critical
of the 4,458 U.S. L&D units reporting that they are not using information at the bedside when and where it is needed.
an automated system (HIMSS Analytics, 10-January-2011) (Figure 3)
(Figure 2)—a statistic that extends to the NICU, validated
Care teams have an immediate source of relative patient
by Drummond’s research. “In late 2008, most NICUs still
information to visualize, access, and act more efficiently. It
integrate[d] multisource clinical data at the bedside by
can help enhance the patient’s health and safety at every
charting each hour with pen in small boxes on folding paper
touch point.
flow sheets—a slow, error-prone, and imprecise method for
tracking unstable situations” (Drummond, 2009). Critical care
decision support systems provide functionalities and features
that allow real-time integration of data with point-of-care
access, streamlined clinical workflow, and data exchange
that supports risk management.
Figure 3.
4

5. Reducing Errors and Risk
Implementing an electronic medical records system can Eden’s pre- and post-EMR implementation study (Eden,
assist in reducing error frequency through decreasing KB, 2008) of the impact on patient record documentation
duplicate entries, improving data efficacy, performing real- completeness demonstrated that paper records were much
time checks, providing alerts, reminders, communication more likely to miss significant clinical information in L&D
improvement, calculation, and monitor assistance. Supplying units as evidenced in Figure 5 using data aggregated
more comprehensive patient information than paper-based from the study.
records enables departments with EMRs to have more
Other studies concur: an obstetric record study demonstrated
complete documentation, a continuity of care record, and
marked improvement in documentation with an 8% increase
increased time in direct patient care, in turn suggesting
in compliance (from 77% to 85%) on a 59-item score sheet
enhancement in patient safety and quality of care.
when analyzing quality of electronic medical records as
Centricity Perinatal’s S Bar helps enhance patient safety and compared to a paper-based system (Haberman S, 2007).
quality of care through increased communication among Another study concluded that use of an intranet-based
caregivers. (Figure 4). computerized prenatal record significantly improved
communication among providers and that replacing paper
Figure 4.
5

6. Clinical Data Paper Electronic
Points Missing Missing
Bleeding 35% 2%
Fetal Movements 20% 3%
Contractions 10% 2%
Membrane Status 64% 5%
Total 129% 12%
Figure 5.
obstetric records with electronic ones reduced the incidence Therapeutic best practices are changing as research
of missing charts from 16% to 2% (Bernstein PS, 2005). And directs new findings; the clinical information found in
a comparison of paper to electronic fetal monitoring archival EMR databases is powering quality reviews, improvement
systems demonstrated higher reliability in an electronic processes, productivity measurements, resource allocation,
documentation system both during the data-capture and budgets. Salt Lake City, UT-based Intermountain
period and storage interval (Stringer, 2010). Healthcare began limiting labor inductions before 39 weeks
after an EMR analysis proved higher admittance to the NICU
EMR systems with embedded clinical decision support
and higher incidences of respiratory distress. Their revised
can “significantly improve access to and compliance with
induction strategy resulted in fewer labor complications and
clinical care guidelines, reduce redundant test ordering, and
emergency C-sections with patient savings of $2 million
ease of data sharing” (Eden KB, 2008). Centricity Perinatal’s
(Sg2, 2010). Furthermore, as accreditation organizations
integrated Alerts & Reminders notify users of site and/or
continually increase focus on and request clinical performance
unit-specific clinical protocols or pathways at the bedside,
measurements, EMRs act as a data repository.
supporting clinical decisions to help enhance safety and
reduce risk. Solution response is optimized by recognizing
multiple simultaneous changes tracked sequentially in
clinical data streams, aligned with evidenced-based practice
guidelines which identify potential complications and offer
interactive assistance.
Figure 6.
6

7. Improving Bottom Line
EMRs need to be evaluated for their return on investment. While “soft” ROI gains such as enhancements in patient
Few, if any, studies exist on “hard” ROI for L&D or within safety, direct quality of care, process and workflow
the NICU environment. However, one such example is from improvement, communication, compliance, stakeholder
Fresno Community Regional Medical Center, which realized satisfaction, and legal risk minimization cannot be translated
more than $70,000 in annual savings (Anderson, 2010). Miller into hard dollars, an EMR’s value is indisputable in terms of
and Tucker’s study roughly estimates that healthcare IT is enhancing care delivery, and its assistance in saving lives.
associated with a cost of $531,000 per infant saved (Miller, 2011).
Maternal Infant Care is a unique part of the hospital’s care
By comparing the IT use in other industries to health care, environment. It requires a special blend of technologies and
it has been estimated that total potential savings could capabilities to provide a seamless flow of vital information to
eventually be in excess of $81 billion annually (Hillestad R, help ensure the health and safety of these patients. Centricity
Bigelow J, Girosi F, Scoville R, & Taylor R, 2005). A recent report Perinatal can play a major role in achieving those goals.
from the Medical Group Management Association estimated
Save time and money with Centricity Perinatal’s customizable
almost $50,000 more revenue after operating cost, per
electronic documentation system. Move from paper charts
full-time-equivalent physician, for non-hospital/IDS-owned
to an intuitive user-friendly digital format, offering potential
practices with an EMR, and reported a 10.1% higher
improvement to your bottom line. It’s Power at the Point of Care.
operating margin after five years (Medical Group, 2010).
References Hon E.H. (1965). In Stacy R.W. & Waxman B (Eds.), Computer aids in evaluating fetal distress. New York:
American College of Obstetricians, & Gynecologists. (2003, October). Patient Safety in Obstetrics and Computers in Biomedical Research.
Gynecology (Committee Opinion 286). Washington, DC Jha A., DesRoches C. (2010). A Progress Report on Electronic Health Records in US Hospitals (Health
American College of Obstetricians, & Gynecologists. (2009, December). Patient Safety in Obstetrics Affairs 29, no. 10, pp. 1951-1957). doi:10.1377/hlthaff
and Gynecology (Committee Opinion 447). Washington, DC Klagholz J., Strunk A. (2009). Overview of the 2009 ACOG Survey on Professional Liability (American
American Medical Association. (2010). Medical Liability Claim Frequency: A 2007-2008 Snapshot of College of Obstetricians and Gynecologists). Retrieved from http://www.acog.org/departments/profess
Physicians (Policy Research Perspectives). Chicago: Kane, Carol K ionalLiability/2009PLSurveyNational.pdf
Anderson, K. (2010). Fresno Community Regional Medical Center Updates Clinical Information System Kohn L.T., Corrigan J.M. (2000). To Err is Human. Washington, DC: National Academy Press.
to Meet NICU Challenges with Centricity Perinatal. Neonatology Today, 5(5), 1-3. Kubli, F., Ruttgers, H., Beard, R. W., Hammacher, K., Hon, E. H., Jung, H., & Saling, E. (1974). Problems
Baglio v. St. John’s Queens Hospital, 303 AD 2d 341 - NY: Appellate Div., 2nd Dept. 2003. Retrieved and significances of electronic monitoring of fetal heart rate (No 34:1). Geburtsh: u.Frauenheilk.
January 7, 2011, from http://scholar.google.com/scholar_case?case=18325712885972675148&hl=en McCoy M., Diamond A. (2010). Special Requirements of Electronic Medical Record Systems in Obstetrics
&as_sdt=800000000002 and Gynecology. American College of Obstetricians and Gynecologists, 116(1), 140-143.
Bates D.W., Gawande A. (2003). Improving Safety with Information Technology. New England Journal Medical Group Management Association. (2010, October 25). MGMA survey: Medical groups with
of Medicine, 348, 2526-2534. EHRs report better financial performance than practices with paper medical records [Press release].
Bernstein P.S., Farinelli C. (2005). Using an electronic medical record to improve communication Retrieved from http://www.mgma.com/press/default.aspx?id=39824
within a prenatal care network [Abstract]. Obstetrics and Gynecology, 105(6), 1488-9. Abstract Miller, Amalia R. and Tucker, Catherine, Can Healthcare IT Save Babies? (April 14, 2011). Available at
retrieved from http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_ SSRN: http://ssrn.com/abstract=1080262
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of Neonatal Informatics. Neoreviews, 10(10), 480-487. doi:10.1542/neo.10-10-e480 Schoen, C., Osborn R., Doty, M. M., Squires, D., Peugh, J., & Applebaum, S. (2009). A Survey of Primary
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Haberman, S., Rotas, M., Perlman, K., & Feldman, J. G. (2007). Variations in compliance with com/glossary/spoliation.html
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Hillestad, R., Bigelow J., Bower A., Girosi F., Meili R., Scoville R., & Taylor R. (2005, September). Can of Electronic Health Record Systems in Pediatrics. Pediatrics, 119(3), 631-637.
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Application.
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8. ©2011 General Electric Company – All rights reserved.
General Electric Company reserves the right to make
changes in specifications and features shown herein,
or discontinue the product described at any time without
notice or obligation.
This white paper is for informational purposes only. The
information in this document represents the current view of
GE on the issues discussed as of the date of publication and
GE accepts no duty to update this document based upon
more current information. GE makes no representations or
warranties regarding the accuracy or completeness of the
information in this document.
Centricity Perinatal does not replace clinical observation and
evaluation of the patient at regular intervals, by a qualified
care provider, who will make diagnoses and decide on
treatments or interventions. Features of the Centricity
Perinatal system are intended to support clinical decision
making and should be used in combination with other clinical
inputs, such as real time patient observation and information
contained within other systems or recording tools. Not
intended to be used as a primary monitoring device.
*GE, GE Monogram, Centricity and imagination at work
are trademarks of General Electric Company.
GE Healthcare, a division of General Electric Company.
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